Today s Topics. Accountable Delivery and Payment Strategies under Healthier Washington. Healthier Washington Initiative

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1 Accountable Delivery and Payment Strategies under Healthier Washington Health Care Authority and King County November 7, 2014 Today s Topics Healthier Washington Initiative Responses to Joint HCA & King County RFI Accountable Delivery & Payment King County Purchasing Vision Comments & Questions Closing 2 1

2 Healthier Washington State Health Care Innovation Plan Goal a Healthier Washington Pay for value and outcomes starting with the State as first mover Empower communities to improve health and better link with health delivery Integrate physical and behavioral health to address the needs of the whole person Critical Legislation Enacted ESHB 2572 Purchasing reform, greater transparency, empowered communities ESSB 6312 Integrated whole-person care 4 2

3 Strategies, Investments & Goals Achieving the goal of a Healthier Washington requires an integrated strategic investment plan. WASHINGTON S APPROACH TO INNOVATION STRATEGIES: 1. Healthy communities 2. Integrated care & social support 3. Pay for value State as first mover INVESTMENTS: 1. Community empowerment & accountability 2. Practice transformation support 3. Payment redesign 4. Analytics: Interoperability and measurement 5. Project management GOALS: Improve population health Transform delivery systems Reduce per capita spending A HEALTHIER WASHINGTON Legislative Support HB 2573, SB Paying for Value State as First Mover Common framework and alignment for 2016 procurement cycle (Medicaid and PEB) VBP emphasizing primary care, care coordination, appropriateness, and EBM Encourage members to pursue quality care State as Market Convener and Organizer Create statewide core measure set All payer claims database Engage stakeholders in payment and benefit redesign and consumer engagement 6 3

4 Paying for Value Activities Purchasing RFI issued in April 2014 New purchasing strategies All payer claims database Legislatively created, 2014 Includes Medicaid and PEBB populations Statewide core measure set Legislatively created, 2013 & 2014 Measure Committee and 3 workgroups currently convened (Prevention, Acute and Chronic Illness) Recommendations due by January Responses to Joint HCA & King County RFI 4

5 RFI Responders Breakdown Providers (13) Major providers and hospital systems One FQHC, and Community Health Centers Association Health Plans/TPAs (15) Most WA commercial health plans including dental All Medicaid Managed Care Plans Others (6) Individual providers Labor DMEs Associations 9 RFI Responses Identified a rapid adoption of value-based reimbursement (VBR) All respondents involved in VBR now with plans to expand over the next five years Consistent quality measures tied to value based purchasing Acknowledgment of the importance of Accountable Care Organizations/Network Establish a long term partnership with Accountable Care Organization/Network ACO partner must be able to manage risk 10 5

6 RFI Responses Other common responses: Clear patient attribution methods that deliver a critical mass of patients Develop meaningful plan designs resulting in higher quality of care, reduced cost and increased access Require selection of a PCP/primary care medical home 11 RFI Responses Other common responses: Recognize care management costs Patient engagement is key Integrate medical and behavioral health Provide provider transformation support Partner must have population management data infrastructure 12 6

7 Accountable Delivery and Payment Paying for Value and Outcomes The Health Care Authority/King County RFI validated the market s readiness for change and helped set HCA s strategic focus and execution plan. Learn Strategy Action RFI HCA & King County EXPECTATIONS Purchased Health Care Annual Goal HCA Health Care cost at 1% below national trend FFS P4P Bundles Alternative Payments Warranty Reference Pricing Shared Savings Shared Risk By % State health care purchasing is value-based Total Cost of Care 14 7

8 Delivery & Payment Models MODEL 1: Early Adopter of Medicaid Integration MODEL 2: Encounter-based to Value-based MODEL 3: Puget Sound PEB and Multi- Purchaser MODEL 4: Greater Washington Multi-Payer 15 HCA Purchasing Timeline PEB Finalize 2016 Accountable Care Product & Strategy Selection Process & Negotiations Partner(s) Selected Final PEBB Board Vote Member Outreach Begins Budget Submittal for 2017 Open Enrollment Activate Operational Systems Accountable Care Product Implemented Oct Dec Feb Apr Jun Aug Oct Dec Feb 16 8

9 Joint Expectations for ACOs Partnerships with health care providers and payers, focused on five specific outcomes: Accountability for costs of care and for annual cost increases Ensuring optimized quality for a defined population Appropriate level of care, emphasizing evidence-based primary care Care coordination strategies resulting in better integrated care Design benefit plans that incentivize patient engagement, education, and experience Additional expectations: Clear quality and performance measures Alternative payment models leading to total cost of care and shared risk with providers EHR, Health IT and data analytics focused on care management and system improvement 17 King County Purchasing Vision 9

10 Decision/Action Timeline JLMIC Input Goals/Principles For Benefits Agree on Key Elements of Benefits Plan With JLMIC Major Constraint JLMIC Benefits MOA Ends Major Constraint Excise Tax Liability Build Business Case For Expanded Plan Solution Launch Medical/Rx RFP Develop New Vendor Performance Criteria & New RFP format 19 Major Constraint Medical/Rx Vendor Contracts End Plan Structure Positive enrollment in ACO required PCP selection strongly encouraged Large differentials in member cost share to incent movement to ACO and HMO KingCare Group Health PPO ACO HMO 20 10

11 Consumer Engagement Requirements: Robust set of personalized consumer tools and incentives to support health literacy Easy to use Include provider quality information from the WHA Community Checkup Report Include tools for framing health care options (i.e. Choosing Wisely) and decisions Multiple access options including mobile apps Potential for on-site care (face-to-face or telehealth) Ease of use and functionality of consumer tools will be assessed by a panel of employees 21 Action Steps for Design Engage Measure Adjust Plan options with strong price & quality performance guarantees Enrollment targets that achieve benefits cost growth targets Price differentials between plan options to maximize enrollment in the higher value plans Educate members on new opportunities for higher value care Provide strong consumer tools to help members make plan, provider and care choices Health plan vendor performance Success in meeting enrollment targets Overall cost results against budget targets Patient activation Adjust plans and incentives as needed on an annual basis Continually improve member health literacy and patient activation level 22 11

12 Questions & Comments For more information, contact: HCA Nathan Johnson Rachel Quinn King County Kerry Schaefer 24 12

13 Where is Washington State? Consolidation Integration